title: Percutaneous endoscopic gastrostomy in amyotrophic lateral sclerosis: effect on survival.
abstract: BACKGROUND
  Percutaneous endoscopic gastrostomy (PEG) is offered to amyotrophic lateral sclerosis (ALS) patients with severe dysphagia. Immediate benefits of PEG are adequate food intake and weight stabilization. However, the impact of PEG on survival is still uncertain. In this work we retrospectively evaluated the effect of PEG on survival in a cohort of ALS patients followed in a tertiary referral centre.
  
  
  METHODS
  Between 2000 and 2007, 150 dysphagic ALS patients were followed until death or tracheostomy. PEG was placed in 76 patients who accepted the procedure and survival was analysed using the Kaplan-Meier life-table method.
  
  
  RESULTS
  In ALS patients submitted to PEG, no major complications were observed. Total median survival time from symptom onset was 38 months for PEG users as compared to 32 months for the remaining dysphagic patients who declined the procedure (p=0.05). Among bulbar-onset patients, PEG users showed a median survival time longer than those with no PEG (28 months vs. 25 months), even though the difference was not significant. Conversely, dysphagic spinal-onset patients with PEG lived significantly longer than those who refused this palliative care (44 months vs. 36 months, p=0.046). Survival in patients with PEG was not affected by the severity of the respiratory impairment, as measured by forced vital capacity.
  
  
  CONCLUSIONS
  This study demonstrates that PEG improves survival in dysphagic ALS patients, with few side effects. The procedure is safe and applicable even to patients with impaired respiratory function. PEG remains a milestone in palliative care in dysphagic ALS patients.
authors.affiliation: ALS Clinical Research Center, Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Spataro
authors.forename: Leonardo
authors.initials: L
authors.lastname: Ficano
authors.forename: Federico
authors.initials: F
authors.lastname: Piccoli
authors.forename: Vincenzo
authors.initials: V
authors.lastname: La Bella
mesh_terms: D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000209:etiology / Q000401:mortality / Q000601:surgery; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome